Introducing Concentra TotalCare and Urgent Care: Solutions for Improving Health Care Accessibility and Affordability in

1. Introducing Concentra TotalCare and Urgent Care:Solutions for Improving Health Care Accessibility and Affordability inNew Hampshire Presented by: Joe Castorina, M.D., MPH Regional Medical Director Tony Silva, Regional Sales Manager

3. What we’ll discuss today… • Current health care environment in New Hampshire. • Understanding the current health trends throughout the country • Changing Behavior through a Worksite Health Improvement Program • How Urgent Care expands accessibility and affordability of care • How your employees can benefit from Concentra Urgent Care • Next steps.

4. The State of Personal Health in New Hampshire New Hampshire ranks well in several measures of personal health: • #2 in overall child health status • #7 in rate of personal exercise • #42 in rate of overweight/obese persons • #45 in rate of hospital admissions • #45 in rate of occupational fatalities • #47 in rate of motor vehicle deaths

5. Perhaps one reason for better overall health in New Hampshire is a younger population than the national and New England averages.

6. And even though overall health measures look good, there is still room for improvement—especially in regards to national ranking on: • Illicit drug use #3 • Cancer incidence #15 • Cigarette smoking #18 • High cholesterol #23

7. Achieving and maintaining good personal health is important in controlling future health care costs, because New Hampshire leads the nation in employer-paid health insurance coverage.

8. New Hampshire employers pay more on average for health care than the national average.

9. Understanding the Current Health Trend Rising U.S. Healthcare Costs Billions of Dollars Source: Centers for Medicare & Medicaid Services Spending expected to increase from $2.3 trillion in 2007 to $4 trillion in 2015.Source: National Coalition on Health Care

10. Understanding the Current Health Trend What is Driving the Increase in Healthcare Costs Medical innovation • Pharmaceuticals - Specialty/Biotech • New technology and specialized testing Reimbursement and coverage • Increasing numbers of uninsured or under-insured • Cutbacks in Medicare/Medicaid reimbursement System issues • Inefficiencies and fragmented care • Medical errors and quality Practice challenges • Defensive medical practice • Preventive care not valued

11. Understanding the Current Health Trend Other Drivers of Increased Costs? Aging population • Aging workforce Lifestyle factors • Diet • Physical inactivity

12. Understanding the Current Health Trend Increasing Health Insurance Premiums • Increases in health insurance premiums have ranged from 6% to 13% since 2000 Source: Kaiser Family foundation • Chronic illness (heart disease, diabetes, and obesity) account for 75% of health care costs. • Source: APHA

13. Understanding the Current Health Trend Healthcare System Fails to Deliver Recommended Preventive Services Source: CDC

14. Understanding the Current Health Trend Worsening Health Status of Population And, the problem is going to get worse without coordinated and effective action …

15. Understanding the Current Health Trend Changes in Dietary Practices Over the past 20 years… • Calories rose 22% from 3200 to 3900 per day • Snacks as portion of daily calories increased >50% • Proportion of food eaten away from home doubled • Food processing has replaced complex grains with refined carbohydrates and simple sugars • Portion sizes grown by 25 – 50%

16. Understanding the Current Health Trend The Growing Problem of Obesity 15 states reported obesity rates from 10% to 14%; none greater than 14% 28 states reported obesity rates from 25% to 29%, and three states > 30%

17. Understanding the Current Health Trend Obesity Epidemic Affects All Age Groups in U.S. Source: CDC, BRFSS

18. Understanding the Current Health Trend • It is Only Going to Get Worse

19. Understanding the Current Health Trend New Cases of Diabetes Among U.S. Adults- Age 18-79 Years ↑ 3 fold in 25 years Source: CDC Nat’l Health Interview Survey and ADA 2007

20. Understanding the Current Health Trend Proportion of Adults with Diagnosed Diabetes by State 2005 1994 Diabetes prevalence rose from 3% in 1984 to 7% in 2004 among US Adults.Source: NDSS, CDC, NHIS and ADA 2007

21. Type II Diabetes Stroke Cardiovascular Disease High Blood Pressure High Cholesterol Pulmonary Disease Sleep Apnea Respiratory Problems Cancers Acid Reflux Disease Psychological/Social Effects Gallbladder Disease Bladder Control Problems Uric Acid Kidney Stones Gout and osteoarthritis Reproductive Issues Women – pregnancy complications, irregular menstrual cycles Men - infertility Musculoskeletal problems Understanding the Current Health Trend Obesity-related Illness and Disease Sources: Weight Awareness and the Centers for Disease Control and Prevention

22. Associated with: 39 million lost work days 239 million restricted days 90 million bed days 63 million physician visits1 Major contributing factor in workers’ comp injuries Accounts for >9% of the total costs of work absenteeism2 Costs U.S. companies $13 billion/year: $8 billion attributable to health care $5 billion attributable to sick leave, life insurance, disability insurance, absenteeism, and presenteeism3 Understanding the Current Health Trend Obesity Impacts Health and Productivity Costs Source: 1Obesity Research 1998 , 2JOEM 2007, 3NBGH 2006

23. Changing Behavior through a Worksite Health Improvement Program • Worksite Solutions that Work • Understand the Production of Disease: Identify health risks and prevent disease and complications • Identify Employees At Risk: Determine those with risks of becoming ill or contracting a disease • Intervene to Promote Healthy Behaviors: Assist employees to lower risk and improve outcomes • Effectively Engage Employees: Communicate health as a priority, build awareness and reinforce health Health Promotion and Communication Health Risk and Biometric Screening Health Education, Coaching and Monitoring Policies, Benefits, and Incentives

24. Changing Behavior through a Worksite Health Improvement Program • TotalCare’s Program Design Elements • Implementation • Program Design and Logistics • Communications Plan • Incentive Coordination 2) Know Your Numbers • Health Risk Assessments (electronic/paper) • Personal Wellness Profile • Biometric Testing 3) Education and Coaching • Employee Health Portal (web tools) • Health Coaching (Onsite/Telephonic) • Education and Coaching (Onsite/Web-based) 4) Manage and Measure • Employer Web Portal/Reporting • Measurements • Executive Consultation Meetings

25. The higher costs of health care in New Hampshire are borne by employers and employees with health insurance. New Hampshire health insurance premiums are the highest in the country.

26. One reason for higher costs is that New Hampshire ranks #12 in hospital emergency room utilization—indicating unmet consumer needs for accessibility and convenience.

27. Up to 75% of hospital emergency room cases could be treated in a lower acuity setting like Urgent Care—for far less money. • Routine Illness: • Seasonal Allergies • Ear Infections • Sinus Infections • Colds/Flu • Rash • Urinary Tract Infection • Health Screenings • X-Ray Services Urgent Care Services • Minor Injuries: • Sprains/Strains • Cuts/Scrapes • Fractures • Back Injuries • Simple Lab Tests • Vaccinations

28. Urgent care charges are comparable to that of a doctor’s office—with greater accessibility—and up to 80% less than emergency rooms.

29. Urgent Care Benefits to Employees and Employers Benefits to Employees: • Available when patients cannot get into primary care • Immediate medical attention for non-emergent conditions • Capabilities beyond a typical primary care office, including x-ray and procedures such as suturing • No appointment ever necessary—just walk in • Shorter wait times • Lower out-of-pocket costs • One consolidated bill • Benefits to Employers: • Reduced absenteeism from illness or caring for sick family members • Increased productivity from early diagnosis and treatment • Decreased utilization of hospital emergency rooms • Greater control over group health costs

30. For patients with in-network insurance, Concentra will collect the co-pay and any patient financial responsibility at time of service, and submit the claim directly to the carrier on the patient’s behalf. Insurance Plans Accepted:

31. Posted Pricing for Self-pay Patients

32. Concentra Concentive$A solution for uninsured, out-of-network and part-time/seasonal employees, uncovered dependents, and for employees in the 90-day new employee benefits waiting period.

33. Next Steps • Concentra’s management team, Tony Silva, is available for appointments to review strategies and options for your clients. • Concentra will help develop a communication plan to educate employees as to the availability and benefits of urgent care. • Concentra will provide collateral including maps, posters, flyers, and Concentive$ to support the communication plan.